Stroke metrics during the first year of the COVID-19 pandemic, a tale of two comprehensive stroke centers.

Although a decrease in stroke admissions during the SARS-CoV-2 pandemic has been observed, detailed analyses of the evolution of stroke metrics during the pandemic are lacking. We analyzed changes in stroke presentation, in-hospital systems-of-care, and treatment time metrics at two representative Comprehensive Stroke Centers (CSCs) during the first year of Coronavirus disease 2019 pandemic. From January 2018 to May 2021, data from stroke presentations to two CSCs were obtained. The study duration was split into: period 0 (prepandemic), period 1 (Wave 1), period 2 (Lull), and period 3 (Wave 2). Acute stroke therapies rates and workflow times were compared among pandemic and prepandemic periods. Analyses were adjusted for age, sex, comorbidities, and pre-morbid care needs. There was a significant decrease in monthly hospital presentations of stroke during Wave 1. Both centers reported declines in reperfusion therapies during Wave 1, slowly catching up but never to pre pandemic numbers, and dropping again in Wave 2. Both CSCs experienced in-hospital workflow delays during Waves 1 and 2, and even during the Lull period. Our results highlight the need for proactive strategies to reduce barriers to workflow and hospital avoidance for stroke patients during crisis periods.

The quality of certification of deaths due to external causes in the city of Fortaleza in the State of Ceará, Brazil.

The article analyzes the quality of information of deaths from external causes in Fortaleza, in the State of Ceará, Brazil. They analyzed the completeness of the information of the death certificate (DO) and the correlation between the underlying cause of death described in the OF and registered in the Mortality Information System (SIM ).We used all the original statements of deaths from external causes, occurred in 2010, of residents in Fortaleza. The study population was 2109 DO. The statements were individually checked seeking to identify the completion of the fields and the basic cause attested the coding of the underlying cause in this DO and compared with the SIM was held. The fields with the highest completion rates were: name (100%), place of residence (100%), mother's name (99.6%), place of birth (99.1%), and sex (98.8%). The fields with the lowest completion rates were: place of occurrence (55%), race/skin color (38.4%), and schooling (34%). They observed inadequacies in the completion of the underlying cause. In DO are reported injuries found and not the circumstances of the death. There was poor level of concordance between the basic cause of DO and registered on the SIM (kappa 0.07). They suggest awareness strategies and training of medical examiners.

Qualidade da informação dos óbitos por causas externas em Fortaleza, Ceará, Brasil / The quality of certification of deaths due to external causes in the city of Fortaleza in the State of Ceará, Brazil

Resumo O artigo analisa qualidade da informação dos óbitos por causas externas em Fortaleza, Ceará. Analisaram-se a completitude das informações da Declaração de Óbito (DO) e a concordância entre a causa básica do óbito descrita na DO e a registrada no Sistema de Informação sobre Mortalidade (SIM). Utilizaram-se todas as declarações originais dos óbitos por causas externas, ocorridos em 2010, de residentes em Fortaleza. A população do estudo foi de 2109 DO. As declarações foram verificadas individualmente buscando-se identificar o preenchimento dos campos e a causa básica atestada. Foi realizada a codificação da causa básica presente na DO e comparada com a do SIM. Os campos com melhor nível de preenchimento foram: nome (100%), local de residência (100%), nome da mãe (99,6%), naturalidade (99,1%), sexo (98,8%). Os campos com pior nível de preenchimento foram: local de ocorrência (55%), raça/cor (38,4%), escolaridade (34%). Observaram-se inadequações no preenchimento da causa básica. Na DO são relatadas as lesões encontradas e não as circunstâncias do óbito. Observou-se nível de concordância fraca entre a causa básica da DO e a registrada no SIM (kappa 0,07). Sugerem-se estratégias de sensibilização e qualificação dos médicos legistas.

Abstract The article analyzes the quality of information of deaths from external causes in Fortaleza, in the State of Ceará, Brazil. They analyzed the completeness of the information of the death certificate (DO) and the correlation between the underlying cause of death described in the OF and registered in the Mortality Information System (SIM ).We used all the original statements of deaths from external causes, occurred in 2010, of residents in Fortaleza. The study population was 2109 DO. The statements were individually checked seeking to identify the completion of the fields and the basic cause attested the coding of the underlying cause in this DO and compared with the SIM was held. The fields with the highest completion rates were: name (100%), place of residence (100%), mother’s name (99.6%), place of birth (99.1%), and sex (98.8%). The fields with the lowest completion rates were: place of occurrence (55%), race/skin color (38.4%), and schooling (34%). They observed inadequacies in the completion of the underlying cause. In DO are reported injuries found and not the circumstances of the death. There was poor level of concordance between the basic cause of DO and registered on the SIM (kappa 0.07). They suggest awareness strategies and training of medical examiners.

Community-acquired urinary tract bacterial infections and drug resistance among patients followed at a reference center in Fortaleza, Ceará, Brazil

Background: The aim of this study was to assess the antimicrobial resistance pattern of the most frequent pathogens responsible for community-acquired urinary tract infection (UTI). Methods: This is a retrospective, descriptive epidemiological survey involving all urine samples submitted for culture and antimicrobial susceptibility testing from patients with clinical diagnosis of UTI followed at the outpatient clinic of the Núcleo de Atenção Médica Integrada, University of Fortaleza, Brazil. The study period was from September 2012 to July 2013. Urine cultures were processed with clean-catch midstream urine samples in the local laboratory employing standard methods. A questionnaire was used to collect patient demographic data and the results of the bacterial identification and susceptibility testing. The data were analyzed by SPSS software. Results: A total of 514 urine samples were analyzed. Most patients were females (78.6%). Patients' mean age was 39 years old. Bacterial growth was observed in 16.5% of the samples. This rate was lower in women (13.6%) than in men (27.3%). The most prevalent pathogen was Escherichia coli (57.6%), followed by Klebsiella sp. (35.3%) and Proteus sp. (4.7%). E. coli showed a high frequency of resistance to ampicillin (88.2%) and sulfamethoxazole/trimethoprim (77.1%), as well as significant resistance to ciprofloxacin (38.9%) and norfloxacin (39.4%). Isolates from elderly patients (>60 years) had higher resistance to all tested antibiotics. Conclusions: There is a trend toward increasing bacterial resistance among the main UTI pathogens. Resistance to sulfamethoxazole/trimethoprim follows a worldwide increase rate tendency and it should be avoided as a first-line empirical treatment for UTIs. A significant resistance to quinolones was also observed.

Uma (re)leitura de estagiários do VER-SUS/Piauí acerca do Sistema Único de Saúde / A (re)reading of ver-SUS/Piauí trainees about the Unified Health System

Este artigo trata de um relato de experiência do projeto:Vivências e Estágios na Realidade do Sistema Único deSaúde ? VERSUS/Brasil, que faz parte da estratégia doMinistério da Saúde e do Movimento Estudantil da áreada saúde, para aproximar estudantes de graduação da realidadedo Sistema Único de Saúde (SUS). A experiênciaocorreu, em julho de 2012, na cidade de Parnaíba, Piauí,onde estudantes de diferentes graduações puderam, a partirda teoria, prática e vivência construir conceitos e refletirsobre questões relacionadas à Saúde Coletiva. A fimde fomentar a construção de um saber transformador, osacadêmicos realizaram visitas pontuais, em diversos ambientesque integram a rede do SUS de Parnaíba, e, a partirde uma metodologia participativa e coletiva em rodas deconversa, discutiram as fragilidades e potencialidades dosserviços e órgãos de saúde visitados, relacionando-as como que preconiza a política pública de saúde. Discutiu-se,também, a Formação em Saúde como uma aliada na consolidaçãodo sistema e o papel da universidade na educa-ção e na formação de profissionais aptos a trabalharemno SUS. Com o estágio, os estudantes puderam imergir narealidade do SUS, superar dificuldades da formação acadêmica,aliar a teoria à prática e perceber as reais demandase necessidades do SUS de Parnaíba.

This article is an experience report on the project:Experiences and Internships in the Reality of theUnified Health System - VERSUS/Brazil - that ispart of the strategy of the Ministry of Health and theStudent Movement of the healthcare area to acquaintundergraduate students with the reality of the UnifiedHealth System (SUS). The experiment took place inJuly 2012, in the city of Parnaíba, Piauí, where studentsfrom different graduating classes could build conceptsand reflect on issues related to Public Health, basedon theory, practice, and experience. In order to fosterconstruction of transforming knowledge, the academicsmade occasional visits to various environments withinthe SUS network of Parnaíba, and based on a collectiveparticipatory methodology, in conversation circles,discussed the strengths and weaknesses of the healthservices and agencies visited, relating them with whatpublic health policy advocates. Health Training as anally in the consolidation of the system and the role ofthe university in education and training of professionalsable to work in the SUS were also discussed. With theinternship, students could immerse themselves in thereality of the SUS, overcome difficulties of the academictraining, combine theory with practice, and perceive thereal demands and needs of the SUS in Parnaíba.